Introduction La satisfaction des patients est un élément clé de la qualité des soins de santé et est reconnue comme un facteur influençant l’engagement, le rétablissement et la confiance. Lors d’une arthroplastie de la hanche et du genou, l’expérience globale est façonnée non seulement par la réussite chirurgicale, mais aussi par la communication, le contrôle des symptômes, la logistique périopératoire et le soutien postopératoire. Cette étude a évalué si la mesure structurée et périodique de la satisfaction des patients pouvait identifier certains aspects modifiables du processus de soins pour ainsi effectuer des interventions ciblées d’amélioration de la qualité dans un hôpital orthopédique privé. Méthodes Pour les années 2022 à 2024, tous les patients subissant une arthroplastie primaire de la hanche ou du genou dans un hôpital orthopédique privé ont été invités à remplir un questionnaire de satisfaction comportant 11 questions, évaluées par une échelle visuelle analogue, ainsi qu’une section de commentaires libres. Les réponses ont été analysées annuellement. Pendant la période d’étude, une rétroaction périodique aux intervenants et des mesures séquentielles d’amélioration de la qualité ont été mises en œuvre sur la base des résultats du questionnaire. Les tendances annuelles des scores de satisfaction et la proportion de commentaires négatifs ont été examinées. Résultats Au total, 2137 questionnaires ont été complétés au cours de la période d’étude (taux de réponse : 68,7 %). La satisfaction globale était élevée (≥9,7/10). Les mesures d’amélioration de la qualité comprenaient une optimisation du suivi infirmier postopératoire, le perfectionnement des protocoles d’analgésie et d’anesthésie périopératoires, des améliorations au service alimentaire et la bonification des informations préopératoires. Des améliorations significatives ont été observées dans les domaines ciblés par les interventions. Au cours de la période d'étude, la proportion de commentaires négatifs a considérablement diminué dans presque tous les domaines. L’analyse des commentaires libres a mis en évidence l’importance d’une communication claire, d’un soutien personnalisé, d’un accès rapide au personnel et d’un sentiment de sécurité émotionnelle. Conclusion L’évaluation structurée et périodique de la satisfaction est une méthode pratique et efficace pour identifier les lacunes exploitables de l’expérience patient et soutenir des améliorations rapides des soins. Même dans un environnement très performant, de petits ajustements ciblés, fondés sur les commentaires des patients, ont conduit à des gains mesurables dans plusieurs domaines. Ces résultats renforcent la valeur d’intégrer les données relatives à l’expérience des patients dans le cadre d’amélioration continue de la qualité, en particulier dans les environnements propices à une mise en œuvre agile. Niveau de preuve IV ; série de cas continue sans groupe de comparaison.

Valgus accounts for 18.5% of patients undergoing a total knee arthroplasty (TKA). Following a mechanical alignment (MA) surgical technique, these patients have historically been more challenging than their varus counterparts. In valgus knees, conventional MA-TKA frequently distalizes and posteriorizes the lateral femoral condyle, increasing lateral patellar retinaculum tension and flexion space imbalance and instability. Personalized arthroplasty is gaining popularity for varus knees, but its value remains debated for valgus knees. This reluctance stems from outdated misconceptions about valgus knee anatomy and biomechanics and limited awareness of advancements in implant survivorship and outcomes. Patients with valgus HKA may present with various knee laxities. While medial collateral ligament (MCL) pseudo-laxity and generalized hyperlaxity are easy to manage, true MCL elongation requires careful evaluation and may necessitate surgical modifications. A surgical approach favoring patellar tracking and avoiding increasing medial compartment gaps is of paramount importance. Joint laxity assessment should guide surgical decisions, from tibial undercutting for mild laxity to soft tissue releases or constrained implants for severe instability. In the presence of a pathological patellofemoral joint, the surgical technique should be adapted with trochlear position/orientation modifications, patellar resurfacing medializing the implant, lateral retinacular release, or a tibial tuberosity osteotomy. Long-term studies show high patient satisfaction with restricted kinematic alignment, TKA in valgus knees, with outcomes comparable to varus knees.

BACKGROUND:Patient satisfaction is a key dimension of healthcare quality and is increasingly recognized as an outcome that influences engagement, recovery, and trust. In hip and knee arthroplasty, the overall experience is shaped not only by surgical success but also by communication, symptom control, perioperative logistics, and postoperative support. This study evaluated whether structured, periodic measurement of patient satisfaction could identify modifiable aspects of care and guide targeted quality-improvement interventions in a high-volume private orthopedic hospital. METHODS:Since 2021, all patients undergoing primary hip or knee arthroplasty at a private orthopedic hospital were asked to complete an 11-item visual analogue satisfaction questionnaire at discharge, with free-text comments. Responses were analyzed annually. Between 2022 and 2024, sequential quality-improvement measures were introduced based on survey findings. Year-to-year trends in satisfaction scores and the proportion of negative comments were examined. RESULTS:A total of 2137 surveys were completed over the study period (response rate: 68.7%). Overall satisfaction was consistently high (≥9.7/10). Quality improvement measures included enhanced nursing follow-up, refinements in perioperative analgesia and anesthetic protocols, improvements to food services, and expanded preoperative information. Significant improvements were observed in domains targeted by interventions. The proportion of negative comments declined markedly across almost all domains. Free-text analysis highlighted the importance of clear communication, personalized support, rapid access to staff, and a sense of emotional safety. CONCLUSION:Structured, periodic satisfaction assessment is a practical and effective method to identify actionable gaps in the patient experience and to support rapid-cycle improvements in arthroplasty care. Even within a high-performing environment, small, targeted adjustments informed by patient feedback led to measurable gains across multiple domains. These findings reinforce the value of integrating patient-experience data into continuous quality-improvement frameworks, particularly in settings capable of agile implementation. LEVEL OF EVIDENCE:IV, continuous case series with no comparison group.

BACKGROUND:Aspirin after an initial short course of rivaroxaban has been shown to be safe and effective for the prevention of venous thromboembolism after total hip or total knee arthroplasty, but uncertainty remains about the use of aspirin alone. METHODS:In this multicenter, double-blind, randomized, controlled trial, we assigned patients to receive once-daily thromboprophylaxis with either 81 mg of aspirin or 10 mg of oral rivaroxaban for the first 5 days after total hip or total knee arthroplasty. All the patients then received further thromboprophylaxis with 81 mg of aspirin daily for 9 additional days after knee arthroplasty and for 30 additional days after hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism, which consisted of either proximal deep-vein thrombosis or pulmonary embolism (primary effectiveness outcome), and for bleeding complications (primary safety outcome). The noninferiority margin for aspirin alone as compared with rivaroxaban-aspirin was 0.7 percentage points. RESULTS:A total of 5429 patients underwent randomization. Venous thromboembolism developed in 13 of 2718 patients (0.48%) in the aspirin-alone group and in 12 of 2647 patients (0.45%) in the rivaroxaban-aspirin group (risk difference, 0.02 percentage points; 95% confidence interval [CI], -0.34 to 0.39; P<0.001 for noninferiority). Major bleeding or clinically relevant nonmajor bleeding events occurred in 45 of 2718 patients (1.66%) in the aspirin-alone group and in 54 of 2647 patients (2.04%) in the rivaroxaban-aspirin group (risk difference, -0.38%; 95% CI, -1.11 to 0.34). CONCLUSIONS:After total hip and total knee arthroplasty, the use of aspirin alone was not inferior to a strategy of using rivaroxaban followed by aspirin for the prevention of symptomatic venous thromboembolism, with no clinically relevant difference in bleeding events. (Funded by the Canadian Institutes of Health Research; EPCAT III ClinicalTrials.gov number, NCT04075240.).

BACKGROUND:Various gait kinematic adaptations have been reported for patients with an anterior cruciate ligament deficient (ACLD) knee. However, to our knowledge, no study has compared their kinematics to their sex-matched controls for the entire gait cycle. Therefore, this retrospective study aims to identify differences in gait kinematics between ACLD patients and sex-matched controls. METHODS:Two databases were merged in this study, comparing knee gait kinematics of 44 injured males (ACLD-M) and 27 injured females (ACLD-F) with 32 healthy males (Control-M) and 37 healthy females (Control-F), respectively. Participants walked on a treadmill at a comfortable speed, and their movements were captured using the KneeKG® system. RESULTS:The ACLD-M group showed a significantly decreased varus angle at several gait cycle sub-phases (from 17-32%, 57-73% and 86-97%; all p < 0.05) and an increased external tibial rotation from 67-86% of the gait cycle (p < 0.001) compared to the Control-M group. The ACLD-F group exhibited increased knee flexion from 1-53% (p < 0.001) and from 95-100% (p < 0.05) and increased valgus from 1-65% (p < 0.001) and from 94-100% (p < 0.05) of the gait cycle compared to Control-F group. CONCLUSION:Our study reveals sex-specific adaptations following ACL rupture. Women exhibited more gait adaption in the sagittal and frontal planes during the stance phase while men demonstrated adaptations in frontal plane for sub-phases of stance and swing, and external tibial rotation during initial and mid-swing phases. These findings suggest that ACL injury kinematics and rehabilitation after injury should be sex-specific. LEVEL OF EVIDENCE III:

Background In total hip arthroplasty (THA), proper management of surgical incisions is essential for optimal wound healing and patient outcomes. Despite advances in surgical techniques, significant challenges remain in preventing complications and infections. This study aimed to identify evidence gaps in THA wound care, including presurgical preparation, intraoperative practices, and postsurgical complications. Methods Using a modified Delphi method, 20 expert orthopedic surgeons from Europe and North America participated in a 3-phase consensus process from April 1 to September 30, 2023. This included a preliminary questionnaire, a remote conference, and a final online survey. The panel reviewed literature and achieved agreement on 18 consensus statements regarding wound care in THA. A secondary aim was to identify critical gaps in current wound care knowledge. Results Consensus was reached on 18 statements. Key gaps were identified in the effectiveness of mesh-adhesive dressings, optimal closure methods (skin adhesives, staples, sutures), cost benefit of barbed sutures, and appropriate use of negative pressure wound therapy. These findings highlight the need for further research to validate best practices and guide standardized evidence-based protocols. Conclusions Addressing these evidence gaps is essential to improve THA wound care methods. Future studies should compare closure techniques and new technologies to develop more efficient patient-centered strategies. Bridging these gaps may reduce complications, enhance outcomes, and lower the burden of wound-related issues in THA.

Contexte Un protocole anesthésique optimisé pour l’arthroplastie articulaire devrait permettre une anesthésie chirurgicale efficace, favoriser une récupération rapide de la fonction motrice et minimiser la douleur postopératoire et les effets indésirables. Pour atteindre ces objectifs, nous avons mis au point le protocole d’anesthésie SOLIS, qui combine une anesthésie rachidienne à courte durée d’action à base de chloroprocaïne, une anesthésie sans opioïdes ni benzodiazépines, de fortes doses d’anesthésiques locaux pour infiltration et une sédation au propofol. Les objectifs de ce rapport descriptif sur l’amélioration de la qualité étaient de déterminer si le protocole SOLIS permettrait d’assurer une anesthésie efficace, d’améliorer la récupération, d’offrir un contrôle adéquat de la douleur postopératoire et de satisfaire les patients subissant une arthroplastie de la hanche ou du genou. Hypothèse Nous avons émis l’hypothèse que le protocole SOLIS permettrait d’atteindre ces quatre objectifs. Patients et méthodes Nous avons examiné 906 arthroplasties unilatérales : 265 prothèses totales du genou, 32 prothèses unicompartimentales du genou et 609 prothèses totales de la hanche. L’efficacité du protocole a été évaluée par le taux de conversion en anesthésie générale et par la durée moyenne du bloc moteur, le délai avant la mobilisation, l’incapacité à se mobiliser le jour de l’intervention et la douleur postopératoire rapportée par les patients. Les événements indésirables et les complications ont été consignés, et un questionnaire subjectif a été utilisé pour évaluer la satisfaction des patients. Résultats Aucun patient n’a dû être converti en anesthésie générale. La durée moyenne du bloc moteur était de 89,7±20,9 (88,0 ; 47,0–198,0) minutes, dépassant la durée moyenne entre l’injection et la fin de l’intervention chirurgicale, qui était de 74,5±16,5 (71,0 ; 39,0–140,0) minutes. Le jour de l’intervention, seulement 1,3 % des patients n’étaient pas en mesure de marcher. Dans l’unité de soins post-anesthésiques, le score moyen de douleur était de 1,7/10±2,2 (1,0 ; 0,0–10,0), 162 patients (17,9 %) ont eu besoin d’opioïdes, administrés par voie orale chez 85 patients (53 %). Les principales complications étaient la rétention urinaire nécessitant un cathétérisme chez huit patients (0,9 %), et l’hypotension orthostatique lors de la première mobilisation chez 42 patients (4,6 %). Une thrombose veineuse profonde est survenue chez deux patients (0,2 %) et une embolie pulmonaire chez un patient (0,1 %). Les patients ont évalué leur satisfaction à 98 % pour le protocole d’anesthésie et à 96 % pour la gestion de la douleur postopératoire. Conclusion SOLIS est un protocole d’anesthésie très efficace pour le remplacement de la hanche et du genou, favorisant une récupération améliorée avec une douleur postopératoire faible et obtenant un taux de satisfaction très élevé chez les patients. Cependant, la mise en œuvre de ce protocole pourrait nécessiter une équipe et un environnement dédiés à l’arthroplastie. Niveau de preuve IV ; série de cas continue sans groupe de comparaison.

BACKGROUND:An optimized anesthetic protocol for joint arthroplasty should provide effective surgical anesthesia, promote early motor function recovery, and minimize postoperative pain and adverse effects. To meet these goals, we developed the SOLIS anesthesia protocol, which combines chloroprocaine short-acting Spinal anesthesia, an Opioid- and benzodiazepine-free anesthesia, large doses of Local anesthetics for Infiltration, and propofol Sedation. The objectives of this descriptive quality-improvement report were to determine whether the SOLIS protocol would provide effective anesthesia, enhance recovery, offer adequate postoperative pain control and be satisfactory for patients undergoing hip or knee replacement. HYPOTHESIS:It was hypothesized that the SOLIS protocol would meet these four objectives. PATIENTS AND METHODS:We reviewed 906 unilateral joint replacements: 265 total knee arthroplasties (TKAs), 32 unicompartimental knee arthroplasties (UKAs), and 609 total hip arthroplasties (THAs). The protocol efficacy was assessed by the rate of conversion to general anesthesia and the mean motor block duration, time to ambulation, the failure to ambulate on the day of surgery, and patient reported postoperative pain. Adverse events and complications were collected, and a subjective questionnaire was used to assess patients' satisfaction. RESULTS:There were no conversions to general anesthesia. The mean motor block duration was 89.7 ± 20.9 (88.0, 47.0-198.0) min, exceeding the mean time from injection to the end of surgery of 74.5 ± 16.5 (71.0, 39.0-140.0) min. On the day of surgery, only 1.3% of patients failed to ambulate. In the post-anesthesia care unit (PACU), the mean pain score was 1.7/10 ± 2.2 (1.0, 0.0-10.0), with 162 (17.9%) patients requiring opioids, which were oral for 85 (53%). Main complications were urinary retention requiring catheterization in eight (0.9%), orthostatic hypotension during the first ambulation was observed in 42 (4.6%). Deep vein thrombosis occurred in two (0.2%), and pulmonary embolism in one (0.1%). Patients rated at 98% their satisfaction with the anesthesia protocol and 96% for the postoperative pain management. CONCLUSION:SOLIS is a very effective anesthesia protocol for hip and knee replacement, promoting enhanced recovery with low postoperative pain, and achieving a very high patient satisfaction rate. However, implementing this protocol may require a dedicated arthroplasty team and environment. LEVEL OF EVIDENCE:IV; continuous case series with no comparison group.

PURPOSE:While restricted kinematic alignment (rKA) total knee arthroplasty (TKA) with cemented implants has been shown to provide a similar survivorship rate to mechanical alignment (MA) in the short term, no studies have reported on the long-term survivorship and function. METHODS:One hundred four consecutive cemented cruciate retaining TKAs implanted using computer navigation and following the rKA principles proposed by Vendittoli were reviewed at a minimum of 10 years after surgery. Implant revisions, reoperations and clinical outcomes were assessed using knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), patients' satisfaction and joint perception questionnaires. Radiographs were analyzed to identify signs of osteolysis and implant loosening. RESULTS:Implant survivorship was 99.0% at a mean follow-up of 11.3 years (range: 10.3-12.9) with one early revision for instability. Patients perceived their TKA as natural or artificial without limitation in 50.0% of cases, and 95.3% were satisfied or very satisfied with their TKA. The mean FJS was 67.6 (range: 0-100). The mean KOOS were as follows: pain 84.7 (range: 38-100), symptoms 85.5 (range: 46-100), function in daily activities 82.6 (range: 40-100), function in sport and recreation 35.2 (range: 0-100) and quality of life 79.1 (range: 0-100). No radiological evidence of implant aseptic loosening or osteolysis was identified. CONCLUSION:Cemented TKA implanted with the rKA alignment protocol demonstrated excellent long-term implant survivorship and is a safe alternative to MA to improve patient function and satisfaction. LEVEL OF EVIDENCE:Level IV, continuous case series with no comparison group.

Background This study reports the minimum 10 years results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head ceramic-on-ceramic bearing. Methods Of the 276 THAs included in this study, there were eleven deaths and 27 patients lost to follow up (11%) during the follow-up, leaving 237 (85%) hips available for review at a mean of 10.5 years (range, 10 to 12) postoperatively. Reoperations, implant revisions, adverse events, clinical outcomes, radiographic evaluation, and whole blood metal ion levels were assessed at the last follow-up. Results After a minimum of 10 years, implant survivorship was 98.7%. There were 3 revisions (1.3%): one for insufficient acetabular cup primary fixation, one traumatic periprosthetic acetabular fracture, and one probable deep chronic infection. No dislocation or ceramic implant fracture was observed. The mean University of California at Los Angeles activity score, Western Ontario and McMaster Universities Osteoarthritis Index score, and Forgotten Joint Score were 5.6 (2 to 10), 90.1 (9 to 100), and 79.2 (4 to 100), respectively. All patients (100%) were satisfied or very satisfied. Since implantation, 43% of patients reported hearing a squeaking noise from the prosthesis. But all patients who reported squeaking were satisfied with the surgery. The mean titanium level was 2.2 μg/L (1.1 to 5.6). No progressive radiolucent lines, osteolysis, or implant loosening signs were observed at the last radiographic evaluation. Conclusions A large-diameter head ceramic-on-ceramic THA provides outstanding long-term (minimum 10 years) implant survivorship with unrestricted activity while avoiding implant impingement, liner fracture, and hip instability. Functional outcomes, satisfaction, and joint perception were excellent. Although the incidence of squeaking was high, it did not affect patient satisfaction or function. The systemic titanium levels were low, related to unavoidable passive corrosion of implant surfaces, and did not reveal any indirect signs of trunnionosis.

Purpose: One of the most pertinent questions in total knee arthroplasty (TKA) is: what could be considered normal coronal alignment? This study aims to define normal, neutral, deviant and aberrant coronal alignment using large data from a computed tomography (CT)-scan database and previously published phenotypes. Methods: Coronal alignment parameters from 11,191 knee osteoarthritis (OA) patients were measured based on three dimensional reconstructed CT data using a validated planning software. Based on these measurements, patients' coronal alignment was phenotyped according to the functional knee phenotype concept. These phenotypes represent an alignment variation of the overall hip knee ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA). Each phenotype is defined by a specific mean and covers a range of +/- 1.5 degrees from this mean. Coronal alignment is classified as normal, neutral, deviant and aberrant based on distribution frequency. Mean values and distribution among the phenotypes are presented and compared between two populations (OA patients in this study and non-OA patients from a previously published study). Results: The arithmetic HKA (aHKA), combined normalised data of FMA and TMA, showed that 36.0% of knees were neutral within +/- 1 SD from the mean in both angles, 44.3% had either a TMA or a FMA within +/- 1-2 SD (normally aligned), 15.3% of the patients were deviant within +/- 2-3 SD and only 4.4% of them had an aberrant alignment (+/- 3-4 SD in 3.4% and >4 SD in 1.0% of the patients respectively). However, combining the normalised data of HKA, FMA and TMA, 15.4% of patients were neutral in all three angles, 39.7% were at least normal, 27.7% had at least one deviant angle and 17.2% had at least one aberrant angle. For HKA, the males exhibited 1 degrees varus and females were neutral. For FMA, the females exhibited 0.7 degrees more valgus in mean than males and grew 1.8 degrees per category (males grew 2.1 degrees per category). For TMA, the males exhibited 1.3 degrees more varus than females and both grew 2.3 degrees and 2.4 degrees (females) per category. Normal coronal alignment was 179.2 degrees +/- 2.8-5.6 degrees (males) and 180.5 > +/- 2.8-5.6 degrees (females) for HKA, 93.1 > +/- 2.1-4.2 degrees (males) and 93.8 > +/- 1.8-3.6 degrees (females) for FMA and 86.7 > +/- 2.3-4.6 degrees (males) and 88 > +/- 2.4-4.8 degrees (females) for TMA. This means HKA 6.4 varus or 4.8 degrees valgus (males) or 5.1 degrees varus to 6.1 degrees valgus was considered normal. For FMA HKA 1.1 varus or 7.3 degrees valgus (males) or 0.2 degrees valgus to 7.4 degrees valgus was considered normal. For TMA HKA 7.9 varus or 1.3 degrees valgus (males) or 6.8 degrees varus to 2.8 degrees valgus was considered normal. Aberrant coronal alignment started from 179.2 degrees +/- 8.4 degrees (males) and 180.5 > +/- 8.4 degrees (females) for HKA, 93.1 > +/- 6.3 degrees (males) 93.8 > +/- 5.4 degrees (females) for FMA and 86.7 > +/- 6.9 degrees (males) and 88 > +/- 7.2 degrees (females) for TMA. This means HKA > 9.2 degrees varus or 7.6 degrees valgus (males) or 7.9 degrees varus to 8.9 degrees valgus was considered aberrant. Conclusion: Definitions of neutrality, normality, deviance as well as aberrance for coronal alignment in TKA were proposed in this study according to their distribution frequencies. This can be seen as an important first step towards a safe transition from the conventional one-size-fits-all to a more personalised coronal alignment target. There should be further definitions combining bony alignment, joint surfaces' morphology, soft tissue laxities and joint kinematics.

Osteopetrosis is a rare metabolic bone disease, characterized by dysfunction of osteoclasts, resulting in increased bone density and brittleness leading to pathological fractures and bone deformities. Hip and knee osteoarthritis (OA) are common long-term complications in patients with osteopetrosis. Joint arthroplasty surgery remains an effective and recommended treatment for these patients with an end-stage OA because it provides favorable outcomes. However, in osteopetrosis, joint arthroplasty surgery carries an increased risk of complications, and specific preoperative and perioperative considerations are required to deal with the technical challenges related to the disease. The aim of this article was to review some of the key aspects of osteopetrosis, provide technical recommendations, and answer clinically relevant questions related to hip and knee arthroplasty surgery.

Over the years, with a better understanding of knee anatomy and biomechanics, superior implant designs, advanced surgical techniques, and the availability of precision tools such as robotics and navigation, a more personalized approach to total knee arthroplasty (TKA) has emerged. In the presence of extra-articular deformities, performing personalized TKA can be more challenging and specific considerations are required, since one has to deal with an acquired pathological anatomy. Performing personalized TKA surgery in patients with extra-articular deformities, the surgeon can: (1) resurface the joint, omitting the extra-articular deformity; (2) partially compensate the extra-articular deformity with intra-articular correction (hybrid technique), or (3) correct the extra-articular deformity combined with a joint resurfacing TKA (single stage or two-stage procedure). Omitting the acquired lower limb malalignment by resurfacing the knee has the advantages of respecting the joint surface anatomy and preserving soft tissue laxities. On the other hand, it maintains pathological joint load and lower limb kinematics with potentially detrimental outcomes. The hybrid technique can be performed in most cases. It circumvents complications associated with osteotomies and brings lower limb axes closer to native alignment. On the other hand, it creates some intra-articular imbalances, which may require soft tissue releases and/or constrained implants. Correcting the extra-articular deformity (through an osteotomy) in conjunction with joint resurfacing TKA represents the only true kinematic alignment technique, as it aims to reproduce native knee laxity and overall lower limb axis.

Background: Large-diameter head (LDH) total hip arthroplasty (THA) with a monobloc acetabular component improves hip stability. However, obtaining initial press-fit stability is quite challenging in atypical acetabula. The purpose of this study was to assess primary and secondary fixation of monobloc cups in atypical acetabula.Methods: In this consecutive case series, the local arthroplasty database was used to retrospectively identify patients with secondary osteoarthritis who underwent primary hip replacement with press-fit only LDH monobloc acetabular components between 2005 and 2018 and who had a minimum of 2 years of follow-up. Radiographic evaluation was performed at last follow-up, and patient-reported outcome measures (PROMs) were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Forgotten Joint Score (FJS), and the Patient's Joint Perception (PJP) question.Results: One hundred and six LDH THAs and 19 hip resurfacings were included in the study. Preoperative diagnoses included hip dysplasia (36.8%), Legg-Calve-Perthes disease (32.0%), osteoarthritis with acetabular deficiency (17.6%), periacetabular osteotomy (8.0%), arthrodesis (4.0%), and osteopetrosis (1.6%). After a mean follow-up of 9.2 years, no aseptic loosening of the acetabular component was recorded nor observed on radiologic review. There were 13 (10.4%) revisions unrelated to the acetabular component fixation. The mean WOMAC and FJS scores were 9.2 and 80.9, respectively. In response to the PJP question, 49.4% of the patients perceived their hip as natural, 19.1% as an artificial joint with no restriction, 31.5% as an artificial joint with restriction, and none as a non-functional joint.Conclusion: Primary press-fit fixation of monobloc acetabular components with LDH implanted in atypical acetabula led to secondary fixation in all cases with low revision and complication rates and great functional outcomes. With careful surgical technique and experience, systematic use of supplemental screw fixation is not essential in THA with atypical acetabula. Contexte: L'arthroplastie pour prothese totale de la hanche (PTH) avec tete de grand diametre (LDH, pour large-diameter head) et composant acetabulaire monobloc ameliore la stabilite de la hanche. Par contre, en presence d'un acetabulum atypique, il est assez difficile d'obtenir une stabilite mecanique directe par effet << press-fit >> (cupule impactee en force dans la cavite acetabulaire prealablement preparee). Cette etude avait pour but d'evaluer la fixation primaire et secondaire de cupules acetabulaires monoblocs en presence d'acetabulums atypiques.Methodes: Pour cette serie de cas consecutifs, nous avons utilise la base de donnees locale sur les arthroplasties afin d'identifier retrospectivement les personnes atteintes d'arthrose secondaire ayant subi entre 2005 et 2018 une arthroplastie primaire pour prothese de hanche avec composants acetabulaires LDH monoblocs et fixation pressfit uniquement, et qui ont pu etre suivis pendant une periode d'au moins 2 ans. Au moment du dernier suivi, des radiographies ont ete effectuees et nous avons evalue les mesures des resultats declares par la patientele (MRDP) au moyen de l'indice WOMAC (indice d'evaluation de l'arthrose des Universites Western Ontario et McMaster), du score de l'articulation oubliee (FJS, pour Forgotten Joint Score), et de la question sur la perception articulaire PJP (Patient's Joint Perception).Resultats: L'etude a regroupe 106 PTH avec LDH et 19 resurfacages de la hanche. Les diagnostics preoperatoires incluaient dysplasie de la hanche (36,8 %), maladie de Legg-Calve-Perthes (32,0 %), arthrose avec insuffisance acetabulaire (17,6 %), osteotomie periacetabulaire (8,0 %), arthrodese (4,0 %), et osteopetrose (1,6 %). Apres un suivi moyen de 9,2 ans, aucun descellement aseptique du composant acetabulaire n'a ete signale ou observe a la radiologie. On a denombre 13 (10,4 %) revisions sans lien avec la fixation du composant acetabulaire. Les scores WOMAC et FJS moyens ont ete de 9,2 et 80,9, respectivement. En reponse a la question PJP, 49,4 % des personnes ont declare avoir la perception d'une hanche naturelle, 19,1 % d'une hanche artificielle sans restriction, et 31,5 % d'une hanche artificielle avec restriction; aucune des personnes interrogees n'a eu la perception d'une hanche non fonctionnelle.Conclusion : La fixation press-fit primaire de composants acetabulaires monoblocs avec LDH implantes dans des acetabulums atypiques a ete suivie d'une fixation secondaire dans tous les cas; les taux de complications et de revisions ont ete faibles et les resultats au plan du fonctionnement ont ete tres bons. Avec une technique chirurgicale minutieuse et de l'experience, l'ajout systematique de vis de fixation n'est pas essentiel pour la PTH dans les cas d'acetabulums atypiques.

BACKGROUND:The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA). METHODS:The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review. Consensus was developed for the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of ≥ 75% was required for consensus. RESULTS:All 26 statements achieved consensus after three rounds of anonymous voting. Wound closure-related interventions that were recommended for use in TKA included: 1) closing in semi-flexion versus extension (superior range of motion); 2) using aspirin for venous thromboembolism prophylaxis over other agents (reduces wound complications); 3) barbed sutures over non-barbed sutures (lower wound complications, better cosmetic appearances, shorter closing times, and overall cost savings); 4) mesh-adhesives over other skin closure methods (lower wound complications, higher patient satisfaction scores, lower rates of readmission); 5) silver-impregnated dressings over standard dressings (lower wound complications, decreased infections, fewer dressing changes); 6) in high-risk patients, negative pressure wound therapy over other dressings (lower wound complications, decreased reoperations, fewer dressing changes); and 7) using triclosan-coated over non-antimicrobial-coated sutures (lower risks of surgical site infection). CONCLUSIONS:Using a modified Delphi approach, the panel achieved consensus on 26 statements pertaining to wound closure and dressing management in TKA. This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA. The results presented here can serve as the foundation for knowledge, education, and improved clinical outcomes for surgeons performing TKAs.

BackgroundThis modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures.MethodsAn international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted.ResultsAfter 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures.ConclusionsThrough a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

BACKGROUND:Total knee arthroplasty (TKA) is considered the gold standard treatment for patients who have advanced hemophilic knee arthropathy. However, special considerations are required for these patients. This prospective study reports on the need for soft-tissue procedures, implant types, complication rates, mean 53.3 months implant survivorship, and patient-reported outcome measures of TKA in hemophilic patients. METHODS:There were twenty primary TKAs that were performed on 15 hemophilic patients from 2012 to 2023. The mean follow-up was 53.3 months (range, 6 to 128). The necessity for additional soft tissue procedures, implant type, complications, and revision rates were recorded. Knee Injury and Osteoarthritis Outcome Score, Knee Society Score, Hemophilia-specific Quality of Life Questionnaire for Adults, Hemophilia Activities List, and range of motion, were compared preoperatively and at the last follow-up. RESULTS:At the last follow-up, implant survivorship was 90%. There were 2 revisions: one for aseptic loosening and one for periprosthetic joint infection. Additional soft tissue procedures included 2 quadriceps snips (10%). Tibial augments, tibial stubby stems, and both tibial and femoral traditional stems were used in one (5%), 4 (20%), and one (5%) TKAs, respectively. A constrained posterior-stabilized bearing was necessary in one case. Clinically and statistically significant improvements were found between the preoperative and final follow-up values of all patient-reported outcome measures, knee flexion (73 versus 108 °, P < 0.001), and flexion contracture (11 versus 4 °, P = 0.002). CONCLUSIONS:This study showed that TKA, in patients who have hemophilic knee arthropathy, is a reliable treatment option that improves knee function and patients' quality of life with acceptable implant survival rates at midterm follow-up (mean 53.3 months). Standard implants and approaches can be used in most cases. Despite good outcomes, hemophilic patients carry additional risks for complications that require specific considerations. It is paramount for these patients to be treated in specialized centers by experienced surgeons to achieve good results.